The bill aims to protect health care consumers from surprise billing by amending various sections of the General Laws. It introduces new definitions, such as "facility fee," which refers to fees charged by health care providers for services in facilities owned by hospitals, and "unforeseen out-of-network service," which includes emergency services and certain non-emergency services rendered by out-of-network providers. The bill prohibits health care providers from charging facility fees unless the services are provided on a hospital campus or in specific emergency situations. Additionally, it mandates that patients receive written notice of any facility fees prior to their appointment, with specific timelines for notification based on the scheduling of the appointment.

Furthermore, the bill establishes penalties for non-compliance, allowing the Department of Public Health to impose fines of up to $1,000 per occurrence for violations. It also requires health care providers to determine their participation in a patient's health benefit plan before services are rendered and to notify patients accordingly. The bill includes provisions for reimbursement rates for out-of-network providers and ensures that patients are only responsible for in-network cost-sharing amounts for unforeseen out-of-network services. Overall, the legislation seeks to enhance transparency in billing practices and protect consumers from unexpected financial liabilities associated with health care services.

Statutes affected:
Bill Text: 175H-1